目的:探讨气道内超声弹性成像技术对肺癌患者肺门纵膈淋巴结转移的诊断价值。方法:选取拟手术治疗的肺癌患者40例,术前予以超声支气管镜检查、淋巴结支气管内超声及弹性成像检查,并予以支气管内超声引导下的经支气管针吸活检术。通过比...目的:探讨气道内超声弹性成像技术对肺癌患者肺门纵膈淋巴结转移的诊断价值。方法:选取拟手术治疗的肺癌患者40例,术前予以超声支气管镜检查、淋巴结支气管内超声及弹性成像检查,并予以支气管内超声引导下的经支气管针吸活检术。通过比较良恶性淋巴结的超声弹性成像特征及弹性成像评分法与常规超声影像学特征诊断恶性淋巴结准确性差异,评估气道内超声弹性成像技术鉴别淋巴结良恶性的价值。结果:1)常规超声影像学特征中鉴别良恶性淋巴结差异有统计学意义的指标包括低回声、回声不均、边界清楚、短径大于1 cm(均P<0.01);2)气道内超声弹性成像评分在良恶性淋巴结中差异有统计学意义(P<0.01);3)弹性评分法对良恶性淋巴结的鉴别明显优于常规超声图像特征中的任何一种。弹性评分≥2.5分诊断恶性淋巴结的曲线下面积(area under the curve,AUC)最大,其诊断恶性淋巴结的特异度、敏感度、阳性预测值及阴性预测值分别为76.9%,85.7%,85.7%及76.9%,诊断的准确率为82.3%。联合指标中以弹性评分联合低回声、边缘清晰、直径大于1 cm诊断价值最大,AUC为0.911,诊断恶性淋巴结的特异度、敏感度、阳性预测值及阴性预测值分别为84.6%,88.1%,90.2%及81.5%,诊断的准确率为86.8%。结论:超声支气管镜下弹性成像技术能有效实现对肺癌患者肺门纵膈淋巴结良恶性的鉴别,比传统的淋巴结支气管内超声的图像准确率高。弹性评分联合常规超声图像特征能提高诊断效率。展开更多
Objective To elucidate the characteristics and metastastic pattern of skipping mediastinal lymph node metastasis (skipping N2) in non-small cell lung cancer (NSCLC), and investigate reasonable extent of lymph node dis...Objective To elucidate the characteristics and metastastic pattern of skipping mediastinal lymph node metastasis (skipping N2) in non-small cell lung cancer (NSCLC), and investigate reasonable extent of lymph node dissection. Methods From 1990 to 1998, lobectomy combined with systematic mediastinal lymph node dissection was performed in 109 patients with NSCLC. A retrospective study was carried out to elucidate the characteristics of skipping N2 disease and to compare the difference between skipping N2 and non-skipping N2 diseases. Results Twenty-one patients (19%) had skipping N2 diseases. Of the skipping N2 group, 18 cases (86%) were adenocarcinoma. Skipping N2 disease was more common in T1 and T2 group than that in T3 and T4 group (P<0.01). All skipping N2 diseases only involved one nodal station, and most of them were regional mediastinal nodal metastasis. Skipping N2 from upper lobe tumors mainly involved superior tracheobronchial or subaortic lymph nodes, and skipping N2 from lower lobe tumors involved subcarinal lymph nodes. Conclusion Skipping N2 disease presents certain clinical characteristics and metastastic pattern, and mediastinal nodal dissection might be modified according to the pattern.展开更多
文摘目的:探讨气道内超声弹性成像技术对肺癌患者肺门纵膈淋巴结转移的诊断价值。方法:选取拟手术治疗的肺癌患者40例,术前予以超声支气管镜检查、淋巴结支气管内超声及弹性成像检查,并予以支气管内超声引导下的经支气管针吸活检术。通过比较良恶性淋巴结的超声弹性成像特征及弹性成像评分法与常规超声影像学特征诊断恶性淋巴结准确性差异,评估气道内超声弹性成像技术鉴别淋巴结良恶性的价值。结果:1)常规超声影像学特征中鉴别良恶性淋巴结差异有统计学意义的指标包括低回声、回声不均、边界清楚、短径大于1 cm(均P<0.01);2)气道内超声弹性成像评分在良恶性淋巴结中差异有统计学意义(P<0.01);3)弹性评分法对良恶性淋巴结的鉴别明显优于常规超声图像特征中的任何一种。弹性评分≥2.5分诊断恶性淋巴结的曲线下面积(area under the curve,AUC)最大,其诊断恶性淋巴结的特异度、敏感度、阳性预测值及阴性预测值分别为76.9%,85.7%,85.7%及76.9%,诊断的准确率为82.3%。联合指标中以弹性评分联合低回声、边缘清晰、直径大于1 cm诊断价值最大,AUC为0.911,诊断恶性淋巴结的特异度、敏感度、阳性预测值及阴性预测值分别为84.6%,88.1%,90.2%及81.5%,诊断的准确率为86.8%。结论:超声支气管镜下弹性成像技术能有效实现对肺癌患者肺门纵膈淋巴结良恶性的鉴别,比传统的淋巴结支气管内超声的图像准确率高。弹性评分联合常规超声图像特征能提高诊断效率。
文摘Objective To elucidate the characteristics and metastastic pattern of skipping mediastinal lymph node metastasis (skipping N2) in non-small cell lung cancer (NSCLC), and investigate reasonable extent of lymph node dissection. Methods From 1990 to 1998, lobectomy combined with systematic mediastinal lymph node dissection was performed in 109 patients with NSCLC. A retrospective study was carried out to elucidate the characteristics of skipping N2 disease and to compare the difference between skipping N2 and non-skipping N2 diseases. Results Twenty-one patients (19%) had skipping N2 diseases. Of the skipping N2 group, 18 cases (86%) were adenocarcinoma. Skipping N2 disease was more common in T1 and T2 group than that in T3 and T4 group (P<0.01). All skipping N2 diseases only involved one nodal station, and most of them were regional mediastinal nodal metastasis. Skipping N2 from upper lobe tumors mainly involved superior tracheobronchial or subaortic lymph nodes, and skipping N2 from lower lobe tumors involved subcarinal lymph nodes. Conclusion Skipping N2 disease presents certain clinical characteristics and metastastic pattern, and mediastinal nodal dissection might be modified according to the pattern.
